tbuckley/cabot-search huggingface dataset:
Abstract 13737: An Electronic Health Record-Based Algorithm to Optimize Secondary Prevention Using Lipoprotein(a), Apolipoprotein B, Cholesterol, and Myocardial Infarction Diagnosis: ABCDs Prevention Program
Authors: Trent B Johnson, William Yang, Zane MacFarlane, Seth S Martin, Francoise A Marvel
Journal: Circulation (2022)

Background : According to the 2022 American Heart Association Heart Disease and Stroke Statistics, coronary heart disease remains the leading cause of death attributable to cardiovascular disease (CVD). In 2016 only ~1 in 4 Medicare beneficiaries who were eligible for cardiac rehab (CR) participated. We explored the use of cardiovascular biomarkers and electronic health records (EHRs) to facilitate the early identification of patients at high risk for CVD. Methods : The EHR algorithm uses a combination of cardiovascular biomarkers and ICD diagnosis codes to automatically identify and refer patients to select secondary prevention programs: (1) traditional CR, (2) lipid clinic, (3) virtual CR (Corrie Health Program). In order to determine program eligibility our model uses criteria of lipoprotein(a) &gt;70 nmol/L, apolipoprotein B &gt;90 mg/dL, low-density lipoprotein cholesterol &gt;150 mg/dL, triglycerides &gt;200 mg/dL , and/or a diagnosis of ST-elevation myocardial infarction (MI) or non-ST-elevation MI as depicted in Figure 1. Lipid biomarker cutoffs were defined to maximize sensitivity for familial hyperlipidemia. Results : In a test environment 90% of patients deemed eligible by the algorithm received appropriate referrals to traditional, virtual (Corrie) CR and lipid clinics. The algorithm is currently being used in both inpatient units and outpatient clinics at Johns Hopkins Hospital and Johns Hopkins Bayview. Sixty-six percent of the orders placed increased referrals to CR and lipid clinic and 33% of the orders placed increased referrals to virtual cardiac rehab. Conclusions : Building an EHR-based algorithm to individualize CVD prevention using cardiovascular biomarkers and diagnoses may increase early identification and intervention on high-risk patients.
Abstract 13205: Mitigating Alarm Fatigue and Improving the Care Provider, Patient, and Family Experience Through Reduction in Non-Actionable Bedside Alarms
Authors: Jeffrey K Yang, Felice Su, Carlos DeSousa, Anna Graber, Haley Hedlin, Shannon Feehan, Angela Graves, Andrew Palmquist, Nicolas Madsen, Rhonda Cable, Alaina Kipps
Journal: Circulation (2022)

Introduction: The burden of bedside alarms is a well-established patient safety hazard with &gt;85% of alarms in ICU settings considered non-actionable or “false alarms”. Healthcare providers risk developing alarm fatigue with potential for prolonged response times and silencing of clinically meaningful alarms. Additionally, alarms disrupt care and cause stress for patients and families. Hypothesis: Creating conditional alarm triggers for bedside monitors can decrease the frequency of non-actionable alarms without compromising safety. The decreased burden of alarms on nurses, patients, and families may promote increased satisfaction. Methods: Single center, quality improvement initiative in a 26-bed cardiac acute care unit and 36-bed pediatric ICU, modeled after successful iterative effort at another tertiary children’s hospital. After 1 month pre-intervention observation of bedside monitor alarm burden, monitors were programmed with hierarchical time delay and conditional pulse oximetry, respiratory rate, and premature ventricular contractions alarm triggers. Bedside alarms were tallied for 1-month follow-up. The primary outcome was alarms per monitored patient day (MPD). Results: A total of 1394 and 776 MPD were evaluated in the pre- and post-intervention periods, respectively. The median number of cardiorespiratory monitor alarms per MPD decreased by 73% (15 to 4, p &lt; 0.001) in both acute care and ICU. Alarm burden in RR, SpO2, and PVC categories also decreased. No increase in frequency of rapid response or code events occurred in either unit. Nursing surveys (n=253) reported positive trends of more manageable alarm burden and decreased perceived number of alarms. Family surveys (n=160), however, reported decreased sleep quality and increased perceived alarms. Conclusions: Implemented changes to bedside monitor alarm conditions decreased total alarm frequency in both cardiac acute care and pediatric ICU without compromising safety.
Abstract 14087: Mitral Annular Calcification and Non-Cardiovascular Outcomes: The Multi-Ethnic Study of Atherosclerosis
Authors: Ebenezer Oni, Ellen Boakye, Gregg S Pressman, Zeina Dardari, Kunal Jha, Moyses Szklo, Matthew J Budoff, Khurram Nasir, Michael J Blaha
Journal: Circulation (2022)

Introduction: Mitral annular calcification (MAC) may be a maker for biological aging. A few studies have showed an association with non-cardiovascular events. We evaluated the association of MAC presence and severity with incident renal failure (RF) and incident dementia in a multiethnic population. Methods: We used data from 6,814 participants in the Multi-Ethnic Study of Atherosclerosis without cardiovascular disease at baseline [53% females, mean age 62 ±10 years; 12% Chinese, 38% White, 22% Hispanic, 28% African American]. MAC [absent/present; 0, 1-99, and ≥100; and &lt;100/≥100 Agatston Units (AU)] was assessed with non-contrast cardiac CT at study baseline. Using multivariable-adjusted Cox proportional hazard regression, we evaluated the association of MAC with RF and incident dementia defined by dementia hospitalizations/death. Results: MAC prevalence was 9.5%; 10.7% in women; 8.0% in men. After a mean follow-up of 13 ± 4 years, individuals with MAC had a higher incidence rate of RF when compared to those without (17.9 vs. 8.1 per 1000 person-years). The incidence rate of RF increased with increasing MAC severity - MAC = 1-99 and MAC ≥ 100 (14.7 and 22.2 per 1000 person-years, respectively). Compared to individuals without MAC, those with MAC ≥100 had a higher multivariable-adjusted risk of RF [Hazard Ratio (HR): 1.41; 95%CI: 1.07 - 1.84; Table 1A ). Also, persons with MAC had a higher incidence of dementia when compared to those without MAC (16.4 vs. 4.1 per 1000 person-years). Persons with MAC = 1-99 AU (HR: 1.38; 95%CI: 1.01 - 1.89) and MAC ≥100 AU (HR: 1.71; 95%CI: 1.25 - 2.33) had significantly higher hazards of incident dementia than those without MAC ( Table 1B ). Conclusion: MAC is independently associated with incident renal failure and dementia in this multiethnic cohort. These findings underscore the utilization of MAC as an important marker of aging and risk of non-cardiovascular outcomes.
Abstract 12861: Demographics and Clinical Characteristics of Patients Presenting With Sinus Bradycardia After Bariatric Surgery
Authors: Francisco Somoza-Cano, Ivan Mogollon, Abdul Rahman Al Armashi, Kanchi Patell, Alejandro Herrera-Ramos, Juan F Toledo-Martinez, Faris Hammad, Keyvan Ravakhah
Journal: Circulation (2022)

Introduction: Sinus bradycardia following bariatric surgery has been described in current literature. Whether certain demographics and clinical characteristics affect this occurrence remains a topic of discussion. Hypothesis: We assessed the hypothesis that certain patient characteristics may affect the prevalence of sinus bradycardia after bariatric surgery. Methods: This cross-sectional analysis nested in a community cohort assessed 321 bariatric surgeries from 2012 to 2020. Due to incomplete data, 179 patients were excluded. A descriptive analysis was made using means and standard deviation (SD) for continuous variables and count and percentages for categorical variables. Odds ratios (OR) were calculated for associations with 95% confidence intervals (CI), and Student’s t-test was used to compare means. Results: For the categorical variables evaluated, only beta blocker usage was significantly different ( p = 0.014) with nearly a tripling of the estimated odds for bradycardia [OR: 2.702 (95%, CI: 1.291 - 5.658)]. For the quantitative measures, only the heart rates showed significant differences between the groups (with and without bradycardia) and they were significant at all follow-up times. Conclusions: Our study showed that sinus bradycardia is a common occurrence among patients undergoing bariatric surgery. The use of beta blockers was significantly predictive of bradycardia. Further studies are needed to evaluate the need for dose reduction or discontinuation of beta blockers in the perioperative period in select cases. Additionally, medical centers should be aware of this development to avoid over-treatment.
Abstract 13251: A Meta-Analysis of Effects of Acetaminophen on Blood Pressure and Heart Rate
Authors: Mostafa R Zaalouk, Mohamed Eid, Mahmoud Ismayl, Ahmad Al-Abdouh, Karam Motawea, Yossef H AbdelQadir, Sarah Mohamed, Sarath lal Mannumbeth renjithlal, Mamas Mamas
Journal: Circulation (2022)

Introduction: Acetaminophen-induced hypotension has been reported previously. It is uncertain whether acetaminophen directly impacts blood pressure and heart rate. Hypothesis: The meta-analysis investigates the effects of acetaminophen on the blood pressure and heart rate, and whether there is a dose-response relationship. Methods: This meta-analysis was conducted according to PRISMA guidelines. A search strategy was designed to utilize PubMed/Medline, EMBASE, and Google scholar for studies showing the effects of acetaminophen on blood pressure and heart rate from inception to February 20, 2022. After screening, 14 clinical trials were included in the analysis. Dichotomous data were pooled as relative risk (RR) and continuous data as mean difference (MD) or standardized mean difference (SMD) using the inverse-variance method. Heterogeneity was assessed using the Cochrane Q test, and its extent was determined by I-square (A value of more than 50% was considered a significant heterogeneity). Results: No statistically significant difference between acetaminophen and control for the overall effect on SBP (MD= -1.52, 95% CI = -4.66 to 1.61, p-value = 0.34) was observed. The findings remained consistent in subgroup analysis by dose, across one gram or less (p-value = 0.54), and more than one gram (p-value = 0.43). Similarly, no statistically significant difference was found for the overall effect on DBP (p-value = 0.61) although we found a statistically significant difference in DBP in the one gram or less subgroup (p-value = 0.02). Finally, we report no statistically significant difference between acetaminophen and control on the MAP (p-value = 0.32) and HR (p-value = 0.18). Conclusions: Acetaminophen has no significant effect on SBP, DBP, MAP, and HR. This effect is consistent with different doses except for a possible increase in DBP after using one gram or less. Further studies are needed to investigate the relevance of this effect.
Abstract 14033: Assessment of Psychology Services Partnered With Clinical Care to Improve Cardiovascular Risk Factor Control
Authors: Joseph Toole, David Freedman, Natasha Vartak, Elizabeth Vrany, Simona Goschin, Jerome Kogan, Eugenia Gianos
Journal: Circulation (2022)

Introduction: Psychological distress greatly impacts cardiovascular disease, and targeted efforts to improve access to psychological services in cardiology care may aid in the reducing of cardiovascular risk factors. The objective of this preliminary study was to assess the impact and characterize the need for and use of short-term psychotherapy in cardiology by partnering a supervised postdoctoral psychology fellow with our cardiovascular prevention and women’s heart programs. Methods: A retrospective chart review was performed from January 2019 to June 2022. Participants included 36 patients engaged in preventive cardiology who attended at least one therapy session (mean age=57.6 years; 72% female; 19.4% Black, 8.3% Hispanic, 47.2% White, 24.9% other ethnicity). If available, hemoglobin A1C, LDL, weight, BMI, and blood pressure were recorded within six months pre- and post-therapy. Results: Mental health diagnoses included MDD (22.2%), GAD (47.2%) and adjustment disorder (25%). Comorbidities included HLD (69.4%), HTN (66.6%), CAD (41.6%) and DM (16.6%). 17 patients were former smokers, and one was a current smoker. More than half (52.8%) attended ≥6 psychotherapy sessions, 38.9% attended ≥6 preventive cardiology visits and 2.7% attended a nutritionist visit in the same time frame. In patients with HTN with both pre- and post-therapy measurements (n=24), 50% were above goal (130/80) pre-therapy and 20.8% post. Regarding weight (n=27), 48.2% lost weight. Among patients with LDL≥100 pre-therapy (n=9), 55.5% achieved LDL &lt;100 post-therapy. Among patients with an A1C≥5.7 pre-therapy (n=8), 12.5% lowered their A1C to &lt;5.7. Conclusions: Although further studies are needed to assess the benefit of each component of care, our preliminary study shows the demand for and potential benefit from psychological services when delivered concurrently with preventive cardiology visits. There was a high level of engagement, with over half of patients attending six or more therapy sessions. Marked improvement in blood pressure, LDL, and weight were noted. These preliminary findings raise the possibility that expanding access to psychological services in clinical cardiology care may be a model to reduce excess cardiovascular risk.
Abstract 12924: The Role of Cardiac Magnetic Resonance Imaging Derived-Right Ventricular Ejection Fraction in Predicting the Risk of Right Heart Failure in Patients Who Underwent Left Ventricular Assist Device Implantation
Authors: Abdulelah Nuqali, Tarun Dalia, Grant McKinley, taher tayeb, Jinxiang Hu, Xiaohang Mei, Thomas Rosamond, Zubair Shah
Journal: Circulation (2022)

Introduction: Despite the advancement in the left ventricular assist devices (LVADs), right heart failure (RHF) remains a challenging adverse event after LVAD implantation and is associated with increased morbidity and mortality. Cardiac magnetic resonance (CMR)-derived right ventricular ejection fraction (RVEF) is a promising surrogate of the right ventricular function and is an independent predictor of major cardiovascular events. In this study, we aim to assess the role of CMR-derived RVEF in predicting the risk of post-LVAD RHF. Methods: We retrospectively assessed adult patients (&gt;18 years) who underwent CMR prior to LVAD implantation at our center from 2016 to 2021. Overall baseline characteristics and clinical outcomes were compared between the patients who developed post-LVAD RHF and those who did not. Results: A total of 42 patients were included in this study. Nine patients (21%) developed RHF; four had early post-implant RHF, and five had late RHF. The mean age was 47±14 years, and 76% were males. Most of the patients were on milrinone infusion at LVAD implantation (69%). The mean cardiac index (using the thermodilution method) was 1.5±0.8 ml/kg/m2, and CMR-derived LVEF was 17±7%. About half of the patients were on destination therapy, and half were on a bridge-to-transplant strategy. The mean CMR-derived RVEF was 25±13%, with no statistically significant difference between the two groups. The mean of the CMR-derived right ventricular volume index trend was higher in those with post-LVAD RHF but did not achieve statistical significance (76±28 ml/m2 vs. 65±25 ml/m2; p=0.31). Patients with post-LVAD RHF had lower mean arterial pressure (MAP) at the time of the right heart catheterization (77±10 vs. 85±12 mmHg; p0.039) and had more HF hospitalizations (2.7±2.2 vs. 0.7±1.5 hospitalizations; p=0.001). Conclusions: In patients who underwent CMR prior to LVAD implantation, CMR-derived RVEF was not an independent predictor of post-LVAD RHF. Larger multicenter studies are needed to confirm this finding.
Abstract 13293: Albuterol and Hyperthyroidism as Potential Causes of Stress Cardiomyopathy
Authors: Santiago Lombo Luque, William Leon, Sandhya Venugopal
Journal: Circulation (2022)

Introduction Takotsubo cardiomyopathy (TCM) is a recognized reversible process associated with emotional or physical stressors characterized by left ventricular apical ballooning in the absence of obstructive coronary artery disease. We present a unique case of TCM after albuterol use in the setting of hyperthyroidism. Results A 74-year-old woman with history of hyperthyroidism and asthma presented with acute substernal chest pain and progressive dyspnea. She was diagnosed with an asthma exacerbation, started oral prednisone 3 days before presentation, and reported using 16 puffs of her albuterol inhaler the day before. Examination revealed blood pressure 157/100 mmHg, heart rate 135 beats per minute, respiratory rate of 35 breaths per minute, and SpO2 94% on a 5-liter nasal cannula. Lung exam revealed bilateral end-expiratory wheezes, and she appeared in respiratory distress. The remainder of the exam was unremarkable, including cardiac exam. ECG revealed atrial tachycardia with ST elevations in the anterolateral leads concerning for injury. High sensitivity troponin was 1484 ng/L (ref &lt;19), free T4 level 3.63 ng/dL (ref 0.56-1.64 ng/dL), TSH &lt;0.02 μU/mL (ref 0.35-3.30 μU/mL ) with TSH-receptor Ab 8.62 IU/L (ref &lt;1.75 IU/L) consistent with worsening hyperthyroidism when compared to one month prior (free T4: 1.19 ng/dL; TSH: 0.84 μU/mL/mL). Emergent cardiac catheterization showed non-obstructive coronary artery disease and reduced ejection fraction (EF) of 30% with akinesia of the anterolateral, apical, and diaphragmatic segments consistent with TCM. She had a full recovery of systolic function noted on repeat echocardiogram 10 weeks after treatment with guideline-directed therapy. Conclusion TCM is primarily driven by a high catecholamine state that, paradoxically, increases β-2 adrenergic receptor inhibitory signaling, thus, causing preferential depression of apical myocardial function possibly due to topographic receptor distribution. Hyperthyroidism mimics a state of adrenergic excess partially mediated by the upregulation of β-adrenergic receptors by thyroid hormones, and the use of β-2 agonists potentiated the development of TCM.
Abstract 14331: Impact of Three-Dimensional Mitral Valve Geometry on Hemodynamic Severity in Rheumatic Mitral Stenosis
Authors: Rodrigo T Giffoni, Judy Hung, João R Medrado Neto, Airandes S Pinto, Lucas B Padua, WILLIAM ESTEVES, Timothy C Tan, Robert Levine, Maria D Nunes
Journal: Circulation (2022)

Introduction: Pathologic derangements of rheumatic mitral stenosis (MS) change valve shape which may determine the hemodynamic severity of the obstruction. This study was designed to assess the role of mitral valve shape on transvalvar pressure gradients in patients with MS. Methods: A total of 186 patients with MS, area of 1.1 ± 0.3 cm 2 , who underwent three-dimensional (3D) transesophageal echocardiographic study, were enrolled. A set of morphological variables to assess the mitral valve (MV) geometry, including diameter, area, height, volume and aortic-mitral angle was obtained using dedicated software. 3D doming index, the proposed index to differentiate between conical and dome shapes, was calculated by dividing the valvar volume (tenting volume) by the valvar height (tenting height). The resulting "average area" was divided by the minimum area of ​​the 3D annulus (Figure 1). Determinants of mean pressure gradient were assessed using linear regression models. Results: The 3D doming index was significantly correlated with transmitral gradient in the multivariate model (p = 0.007), adjusted for age, sex, heart rate, pulmonary artery systolic pressure, net atrioventricular compliance (C n ), and left atrial volume. Specifically, the inclusion of 3D doming index in a model with other factors that influence gradients resulted in improvement in model performance evaluated by R 2 which increased from 0.57 to 0.60. In the 152 patients who underwent successful percutaneous valvuloplasty, there was a significant correlation between the percentage of increase in the valve area and 3D doming index (r = 0.2; p &lt;0.026), after adjustment for the echo score revisited. Conclusions: In rheumatic MV stenosis, 3D geometric shape was associated with transmitral pressure gradient, independent of other parameters. 3D Doming index correlated with the percentage increase in MV area in a subgroup undergoing valvuloplasty.
Abstract 13548: Impact of Guideline-Directed Statin Intervention for Primary Prevention in Patients With Diabetes Mellitus
Authors: Pallavi Muluk, Jianhui Zhu, Floyd W Thoma, Eli Hay, Oscar C MARROQUIN, Amber Makani, Anandita P Agarwala, Aryan Aiyer, Khurram Nasir, Suresh R Mulukutla, Anum Saeed
Journal: Circulation (2022)

Background: The 2018 ACC/AHA Guidelines suggest patients with diabetes mellitus should receive moderate-high intensity statin therapy for primary prevention of ASCVD. We investigated diabetic and non-diabetic patients to evaluate the magnitude of benefit of guideline-directed statin intervention (GDSI) in each cohort. Methods: Primary prevention patients were categorized into diabetes (HbA1c&gt;6.5%) and no-diabetes and stratified based on 10-year ASCVD risk (Borderline [5%-7.4%], Intermediate [7.5-19.9%], or High [&gt;20%]). GDSI prior to first event was determined to be moderate to high intensity statin therapy for moderate and high-risk groups. Mean (±SD) time to start/change to GDSI was calculated from first interaction in health care. Cox regression assessed HRs of myocardial infarction (MI), stroke, and mortality with statin use. Results: Among 282,298 patients, 253,491 were non-diabetic and 28,807 had diabetes. Among diabetic patients at intermediate and high-risk, about 50% received GDSI initially, which rose to about two-thirds at 5y. In fully adjusted models, no statin use showed a higher risk of MI, stroke, and mortality compared to GDSI in all patients (Table). Compared to non-diabetics, diabetics on no statin versus GDSI had a higher risk of mortality and stroke in both intermediate risk [HR mortality 2.18 (1.79-2.65) vs 1.58 (1.45-2.72); all p&lt;0.01] and high risk [HR mortality 1.81 (1.58-2.07) vs 1.41 (1.26-1.57); all p&lt;0.01] groups (Table). Interaction analysis for mortality was significant (p&lt;0.001) by diabetes status. Low statin vs GDSI did not significantly increase risk of ASCVD, except for mortality in the high-risk diabetes group. Conclusions: Significant gaps remain in achieving GDSI, and diabetic patients not treated with GDSI have a higher risk for adverse outcomes, specifically mortality, than non-diabetics. We must develop more aggressive measures to achieve GDSI in all patients, particularly those at highest cardiovascular risk.